[Leukoplakia of the vocal cords. Diagnosis and treatment].
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Biopsy↗
Biomedical subjects
A Giovanni
Publications and source records attributed to A Giovanni.
[Comparison of different phonetic materials for perceptive analysis of dysphonia].
The authors describe a prospective study whose aim was to analyse the influence of the choice of phonetic material on the judgment of the panel. De Krom has already reported an experiment in which perceptive analysis showed that a sustained vowel was a useful material provided that the attack transitory was included (so called complete sustained vowel). He also showed that the panel gave more consistent results with speech or the complete sustained vowel than with the stable part of the sustained vowel. Our first objective was to find out whether we agreed with Krom's results, because for the study in the Dutch language to be applied to the French language, it was necessary to carry out an experimental validation given the cultural differences which might prejudice the results. In additional, we thought it likely that some acoustic information which was present in the attack transitories and was lacking in the stable part of the sustained vowel would run the risk of under-valuing the dysphonia in a study carried out on the stable part of sustained vowels. Our second objective was therefore to demonstrate that in cases of dysphonia, assessment based on the stable part of sustained vowels would be more lenient than those based on speech. The study was carried out using 80 voice samples from 60 dysphonic patients and 20 control subjects. The panel was made up of 7 experienced listeners. Agreement in the jury was judged by the percentage of identical responses given on 3 different presentations of each speech sample. This study showed no differences in the agreement of panel members over the three types of material by changing the severity of classification by the panel was analysed as follows: 1--Pearson r correlation coefficient, comparing on the one hand speech (the reference variable), and on the other samples of the complete vowel and the isolated stable part of the valve (tested variables). 2--A linear regression analysis. Our results confirm that assessments carried out on a sustain/vowel tend to cause a more lenient assessment than those carried out on speech. The assessment carried out on sustained vowels when the attack transient is included were of similar valued to those carried out using speech.
Adult↗
[Medialization of paralysed vocal cord by expansive polytetrafluoroethylene implant (Gore-Tex)].
We report a technique for medialization of a paralyzed vocal cord using a Gore-Tex (expanded polytetrafluoroethylene) implant inserted under local anesthesia via a cervical incision. Gore-Tex is an expanded form of Teflon. It is used in vascular surgery (vessel repair) and esthetic surgery (particularly to increase lip volume). In esthetic surgery, the development of inflammatory processes difficult to control have been observed with teflon and appear to be less frequent with Gore-Tex due to the absence of free particles in the expanded form. The minimally invasive technique is simple and reproducible and can be performed under local anesthesia. We report a series of 9 cases operated from October 1995 to October 1997. During this period, this technique predominated (two other patients had Teflon injections). Excepting one case of extrusion of the implant material, vocal results were very satisfactory, based on both subjective and objective analysis of vocal parameters. The contribution of this technique in comparison with the reference endoscopic techniques (Teflon, collagen) and surgical techniques (silicone, cartilage) is discussed. Early results would suggest that Gore-Tex implantation can be used in the more severe forms due to vocal cord paralysis in the lateral position.
Adult↗
Neonatal hippocampal lesions induced hyperresponsiveness to amphetamine: behavioral and in vivo microdialysis studies.
The effect of neonatal hippocampal lesions on behavioral sensitivity to amphetamine (AMPH) and dopamine (DA) release in the nucleus accumbens (NAc) were examined. The ventral hippocampus was damaged bilaterally by ibotenic acid on postnatal day 7 (PD7). Spontaneous exploration and AMPH-stimulated locomotor activity were examined on postnatal day 35 (PD35) and day 56 (PD56). Extracellular DA, dihydroxyphenylacetic acid (DOPAC), homovanillic acid (HVA), and 5-hydroxyindoleacetic acid (5-HIAA) were sampled using in vivo microdialysis while simultaneously AMPH-stimulated locomotion was examined in freely moving rats on PD56. Spontaneous exploration increased in rats with hippocampal lesions relative to controls on PD56 but not PD35. AMPH (0, 0.187, 0.375, 0.75, 1.5, and 3 mg/kg) enhanced locomotion dose-dependently in both control and lesioned groups. Locomotor activity was higher in lesioned rats than controls following AMPH at the dose of 0.75 mg/kg on PD35 and at the doses of 1.5 and 3.0 mg/kg on PD56. The basal level of DA in the NAc was not different between the hippocampal and control groups. AMPH (1.5 mg/kg) induced hyperlocomotion in lesioned rats relative to controls. DA release in the NAc for both groups was enhanced following injections of AMPH. However, neonatal hippocampal lesions had no further enhancement on AMPH-stimulated release of DA as compared to the control group. The levels of DOPAC and HVA in the NAc were altered by AMPH but not lesions. The level of 5-HIAA was not influenced by either lesions or AMPH. The results of neonatal lesion-induced hyperlocomotion suggest that an emergence of behavioral hyperresponsiveness to AMPH was dependent on an interaction of lesions, age of examination, and dose of the drug. A dissociation between the effect of AMPH on lesion-enhanced hyperlocomotion and a lack of a lesion-enhanced DA release in the NAc suggest that presynaptic release of DA had no major contribution to lesion-enhanced DA transmission in the mesolimbic DA system.
Aging↗
Objective evaluation of dysphonia: preliminary results of a device allowing simultaneous acoustic and aerodynamic measurements.
Voice quality analysis was performed in 88 normal speakers and 157 dysphonic speakers using a device that allows simultaneous study of acoustic and aerodynamic parameters during pronunciation of a sustained /a/. We compared the results with those of voice quality grading by a jury. The Mann-Whitney test showed significant differences between the grades of dysphonia for all the parameters chosen. Comparison of results (using discriminant factorial analysis) with perceptual evaluation by a jury showed concordance in 66.1%. Based on these preliminary results, the authors conclude that their protocol overlooks some relevant voice parameters like middle-term variations. Further study will be undertaken to take into account this type of variations.
Adolescent↗
[Preliminary study of acoustic and aerodynamic parameters after Tucker frontal anterior laryngectomy].
Currently, not objective method has been demonstrated to be reliable for the evaluation of vocal handicap after partial laryngectomy. Such a tool would allow objective assessment of the post-operative voice and its clinical course as well as a comparison of different surgical techniques in terms of voice quality. We used a EVA device to measure simultaneously acoustic and aerodynamic parameters. We included 23 normal subjects and 34 patients who had undergone a Tucker laryngectomy. All subjects were males. At sustained voice production, acoustic measures of vibration stability (jitter, coefficient of variation in the fundamental frequency, shimmer, coefficient of variation in intensity) and air leak from the glottis (buccal air flow over intensity). The quality of voice in operated patients was judged by a jury of listeners who assigned a global score to voice quality. Results were analyzed to verify the correlation between objective measurements and the jury's score, taken as the reference measurement. The pertinence of the objective measurements was demonstrated for the stability of the frequency and the glottal air leak. Multiple regression analysis demonstrated that total variance of the objective measurements accounted for 84.7% of the scores provided by the jury (R2 = 0.847, p < 0.0001). These satisfactory results emphasize the interest of multiparametric analysis including aerodynamic measurements. These preliminary results led to the hypothesis that objective and subjective measurements could be useful in techniques aimed at improving voice quality (temporal organization of vibratory instability, work on intralaryngeal pressures).
Acoustics↗
Estimating hydroxyl radical content in rat brain using systemic and intraventricular salicylate: impact of methamphetamine.
Free radicals have been implicated in the etiology of many neurodegenerative conditions. Yet, because these species are highly reactive and thus short-lived it has been difficult to test these hypotheses. We adapted a method in which hydroxyl radicals are trapped by salicylate in vivo, resulting in the stable and quantifiable products, 2,3-dihydroxybenzoic acid (DHBA) and 2,5-DHBA. After systemic (100 mg/kg i.p.) or intraventricular (4 mumol) administration of salicylate, the amount of DHBA in striatal tissue correlated with tissue levels of salicylate. After systemic salicylate, the ratio of total DHBA to salicylate in neostriatum was at least 10-fold higher than that observed after central salicylate. In addition, systemic salicylate resulted in considerably higher concentrations of 2,3- and 2,5-DHBA in plasma than in brain. Therefore, a large portion of the DHBA present in brain after systemic salicylate may have been formed in the periphery. A neurotoxic regimen of methamphetamine increased the concentration of DHBA in neostriatum after either central or systemic administration of salicylate. The increase in 2,3-DHBA after the central administration of salicylate was significant at 2 h, but not at 4 h, after the last dose of methamphetamine. These results suggest that (1) when assessing specific events in brain, it is preferable to administer salicylate centrally, and (2) neurotoxic doses of methamphetamine increase the hydroxyl radical content in brain in a time-dependent manner.
Animals↗
[Objective vocal evaluation of dysphonia by simultaneous measurement of acoustic and aerodynamic parameters with the EVA device].
Authors present the analysis of the voice in 88 normal subjects and 159 dysphonic patients by simultaneously measurements of Jitter (acoustical short-term indicator of aperiodicity) and "Glottal Leakage" (aerodynamic parameter calculated by the ratio of Oral Airflow and Intensity). All the measurements were performed, with EVA apparatus, on the most stable part of a steady-state vowel /a/. The reference method was the rating by a jury along a global perceptual scale. Statistical tests confirm that Jitter and "Glottal Leakage" are relevant to evaluate the quality of the voice. Discriminant analysis allows to find out a fairly-good rate of discrimination of 63.1% (Randomly rating would have been 25%) The authors conclude on the interest of such a protocol and present suggestions to improve it by taking in count phénomena during the vocal attack and middle-term variations.
Acoustics↗
[Phonetic results after surgery of laryngotracheal stenoses in children].
The quality of the results of laryngotracheoplasties is clear evidence of the progress made in the treatment of stenoses involving the larynx and the trachea in children. the surgeon is no longer limited to helping the child breath correctly via the natural airways but can also concentrate on phonatrics since dysphonia is frequent after laryngotracheoplasty. Vocal production of 23 children who had undergone surgery for laryngotracheal stenosis was evaluated subjectively by a panel of listeners and objectively on the basis of the pitch and intensity of the voice, rate of speech and maximal time of phonation. In 11 children over the age of 5 years, assisted assessment of the voice completed the study. In 69.5% of the cases, the voice was subjectively considered to be satisfactory. Voice was considered clear in 52% of the cases. Speech flow was impaired in 39% due to frequent breath taking. Objective parameters revealed that pitch was slightly impaired (256 Hz) with a tendancy to normalize near puberty. The intensity of the voice (77 dB) and mean maximum phonation time (7 s) decreased. The phonotary quotient (270 ml/sec), jitter (1.4%) and leakage of the glottis (2.02 cm3/dB/s) were slightly above the normal range. The spectra of the voices were richly furnished with harmonics up to about 1 000 Hz above which air noises increased. An attempt was made to correlate the analysis of the voice with the characteristics of the stenosis and with the therapeutic methods used. The results would suggest the iatrogenic nature of prolonged canulation and of increasing the size the size of the posterior cricoid.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
[Reconstructive anterior frontal laryngectomy. Long-term results in T2 glottic cancers].
Between 1982 and 1992, we performed near total laryngectomy with epiglottic reconstruction in 142 patients with state T1 and T2 according to the 1987 Union Internationale contre le Cancer. In this paper, we report our experience with 61 T2 patient who were followed-up 5 years or until death. Actuarial survival was 83%. Actuarial tumor control was obtained in 91%. There were no post-operative mortalities and follow-up was usually simple. All patients underwent decanulation and were able to eat by normal track. The main drawback of this technique is speech disability. We use near total laryngectomy with epiglottic reconstruction in certain T2 patients selected according to local extension. This choice is justified by good functional results and an excellent local control. The contraindications are age over 75 years, poor patient cooperation, cardiac or pulmonary disease, fixation of the arytenoids, subglottic extension of more than 1 cm in front and 0.5 cm laterally, and extensive involvement of the ventricular folds or anterior commissure.
Adult↗
[Surgical approach of the petrous vertical segment and upper cervical internal carotid].
The main obstacle to successful management of aneurysms involving the high cervical internal carotid artery (ICA) is to obtain an adequate exposure. In this report we describe our experience in 5 patients presenting carotid aneurysms at the skull base, intermediately below the carotid foramen. Exposure is achieved in two stages. The cervical stage consists in resection of the styloid processes and muscles followed by anterior displacement of the mandibular condyle. This exposes the vertical segment of the petrous ICA. The petrous stage consists in partial petrectomy exposing the jugular bulb and the third segment of the facial nerve. Using this route, the vertical intrapetrous segment of the ICA can be drilled away without damaging the middle ear. In our series, no vascular complications occurred. Damage involving the facial glossopharyngeal and vagal nerves is discussed. This approach appears to be a suitable alternative to the conventional infratemporal approach which sacrifices the middle ear.
Adolescent↗
Studies on species sensitivity to the dopaminergic neurotoxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine. Part 1: Systemic administration.
Several parameters necessary for the expression of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced neurotoxicity to dopaminergic neurons were examined in both mice and rats in order to determine if differences in these processes might underlie the marked differences in the sensitivity of the two species to the neurotoxic effects of MPTP. Monoamine oxidase-B activity was greater in brain tissues from rats than from mice. The kinetics of 1-methyl-4-phenylpyridinium (MPP+) uptake into neostriatal synaptosomal preparations from the two species were similar. Brain and neostriatal levels of MPP+ were 2-fold higher in rats after the administration of MPTP at 60 mg/kg and were 10 to 20 times higher in rats than in mice after MPTP treatment which produced similar decrements in the content of neostriatal dopamine. MPP+ concentrations in the extracellular fluid of the neostriatum of the two species were similar after the administration of the same dose of MPTP (40 mg/kg). However, this dose induced a 40-fold increase in neostriatal dopamine efflux in mice, whereas in rats only a 3-fold increase was observed. In addition, pretreatment of rats with guanethidine, a ganglionic blocking agent, permitted the use of high doses of MPTP which resulted in substantial damage to the striatal dopaminergic nerve terminals. It is concluded that nigrostriatal dopaminergic neurons in the rat require exposure to a much higher concentration of MPP+ than do those in mice for the induction of toxicity.
1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine↗
Studies on species sensitivity to the dopaminergic neurotoxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine. Part 2: Central administration of 1-methyl-4-phenylpyridinium.
There are marked species differences in susceptibility to the neurotoxic effects of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). Mice are sensitive, whereas rats are relatively insensitive to MPTP. In these two species, the effects of peripherally administered MPTP or intrastriatally infused 1-methyl-4-phenylpyridinium (MPP+) were examined to identify potential underlying mechanisms responsible for their difference in susceptibility to MPTP. In vivo intrastriatal microdialysis and an MPP+ 2-day test/challenge paradigm were used to monitor dopamine efflux as an indicator of the neurotoxic effects of MPTP or MPP+. By using this method, the EC50 for neurotoxicity by an intrastriatal infusion of MPP+ in mice was 0.4 mM, whereas it was 10-fold higher in rats (4.3 mM). In addition, by using the traditional postmortem examination, neostriatal dopamine was depleted markedly in mice (> or = 80%), but only depleted marginally in rats in which MPP+ was infused into the neostriatum. These data indicate that rats are relatively insensitive to MPTP as compared to mice, because they are less sensitive to MPP+ whether it is formed in vivo from MPTP administered systemically or administered directly into neostriata. Thus, there appears to be a fundamental difference in the susceptibility of the nigrostriatal systems in these two species to the neurotoxic consequences of MPP+ exposure.
1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine↗
[Nodules and paranodular lesions: a trial of anatomo-clinical correlation].
The use of increasingly powerful diagnostic tools has enabled the laryngologist to refine the diagnosis of nodular lesions, and, within this group, to isolate clinical variations, paranodular lesions, mucosal thickening, mucosal pseudo-cysts. Systematic comparison between the clinical and anatomopathological diagnosis of the lesions operated upon does not make it possible to establish a strict correlation between the clinical and the histological aspects. Nevertheless, histology appears to throw light on the physiopathology of such lesions within the field of dysfunctional laryngopathies.
Fiber Optic Technology↗
[Multiparameter analysis of dysphonia using the equipment Physiologia].
The purpose of the multiparametric analysis of the vocal phenomenon is to evidence the instability of the signal in amplitude and in frequency, together with the aerodynamic phenomena related to the glottic air leakage. Statistical analysis has made it possible to establish a correlation between the data of the apparatus, as from 9 variables, and the clinical classification. The main diagnostic categories are relatively close, evidencing the various biomechanical anomalies of the laryngeal vibrator. A certain number of issues remain to be addressed: the physiopathology of the vibrator, the choice of the phonetic sample, and the different methods of instrumental analysis.
Biomechanical Phenomena↗
[Cholesteatoma of the middle ear in children. Apropos of 80 cases and review of the literature].
Cholesteatoma occurs in 10% of cases of chronic otitis in children. In most children, the clinical form is very similar to acquired cholesteatoma in the adult. However, we observed certain clinical variations in our retrospective series of 80 cases seen in our unit over the past 8 years. In most all cases, otorrhoea and hypoacousia were the presenting signs. The tympanic membrane was fully intact in 10% of the cases raising the possibility of congenital pathogenesis. An analysis of the correlations between per-operative observations and tomodensitometric results was conducted. Closed tympanoplasty, with a second operation 11 months later, was performed in 84% of the cases. Residual cholesteatoma was observed in 41% of the second operations and relapse occurred in 16%. These anatomic and functional findings, compared with those in the literature, demonstrate that no major difference in the published series. Presently the most important point is to separate acquired and congenital forms, which differ in terms of pathogenesis and clinical presentation, but are treated in the same manner. Progress in the treatment of cholesteatoma of the middle ear in children will come from prevention through earlier diagnosis of pathological manifestations in the ear nose and throat, in particular blocked Eustachian tubes, and through follow-up and treatment of pre-cholesteatomous states, as well as further advances in fundamental research.
Adolescent↗
Characteristics of dopaminergic neurotoxicity produced by MPTP and methamphetamine.
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Animals↗
MK-801 fails to protect against the dopaminergic neuropathology produced by systemic 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine in mice or intranigral 1-methyl-4-phenylpyridinium in rats.
Previous studies from this laboratory demonstrated that (+)-5-methyl-10,11-dihydro-5H-dibenzo[a,d]cyclohepten-5,10-imine maleate (MK-801), an N-methyl-D-aspartate (NMDA) receptor antagonist, did not prevent neurotoxicity to dopaminergic neurons in mice produced by systemic treatment with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). However, Turski et al. [Nature 349, 414-418 (1991)] reported that extended treatment of rats with NMDA receptor antagonists (six injections at 4-h intervals) did prevent the loss of nigral dopaminergic neurons resulting from an intranigral infusion of 1-methyl-4-phenylpyridinium (MPP+), the neurotoxic metabolite of MPTP. The present studies examined if a similar extended treatment with MK-801 would protect mice from the neurotoxicity of systemically administered MPTP. Six intraperitoneal injections of MK-801 given at 4-h intervals did not protect mice against the MPTP-induced neostriatal dopamine loss measured 1 week after treatment. In other experiments, designed to replicate and expand on the results of Turski et al. (1991), the extended treatment of rats with MK-801 did not prevent MPP(+)-induced cell loss in the infused substantia nigra pars compacta or the dopamine depletion in the ipsilateral neostriatum at 7-11 days after MPP+ infusion. These results do not support the hypothesis that NMDA receptors are involved with MPTP/MPP(+)-induced neurodegeneration.
1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine↗